A Critical Appraisal of Implantable Cardioverter-Defibrillator Therapy for the Prevention of Sudden Cardiac Death
Roderick Tung, MD*,
Peter Zimetbaum, MD and
Mark E. Josephson, MD
Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Figure 1 Antiarrhythmic Therapy Can Perform Worse Than Placebo
Inferior performance of antiarrhythmic therapy compared with control group in the SCD-HeFT (Sudden Cardiac Death Heart Failure Trial) trial New York Heart Association functional class III patients (top) and the MUSTT (Multicenter Unsustained Ventricular Tachycardia Trial) trial (bottom). CI = confidence interval; EPG = electrophysiology-guided; ICD = implantable cardioverter-defibrillator.
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Figure 3 Appropriate Shocks Outnumber Control Arrhythmic Mortality in 6 of 7 Trials
AMIOVIRT = Amiodarone Versus Implantable Cardioverter Defibrillator Trial; AVID = Antiarrhythmics versus Implantable Defibrillators trial; DEFINITE = Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation trial; DINAMIT = Defibrillators in Acute Myocardial Infarction Trial; ICD = implantable cardioverter-defibrillator; MADIT II = Multicenter Automatic Defibrillator Implantation Trial II; MUSTT = Multicenter Unsustained Ventricular Tachycardia Trial; SCD-HeFT = Sudden Cardiac Death Heart Failure Trial. Adapted from Germano et al. (28).
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Figure 4 Proarrhythmia From Local Lead Effects?
Patient A presented with slow ventricular tachycardia initially, and rapid ventricular tachycardia induced in the laboratory was successfully pace terminated from the right ventricular catheter directly adjacent to the implantable cardioverter-defibrillator lead with paced morphology identical to tachycardia. Patient B presented with 28 implantable cardioverter-defibrillator shocks, and the closest pace map was from the right ventricular catheter adjacent to the implantable cardioverter-defibrillator lead in the apex.
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Figure 5 Lethal Proarrhythmia
Inappropriate shocks for electrical noise in a primary prevention implantable cardioverter-defibrillator recipient with a Sprint Fidelis lead. The sixth and final shock induced ventricular fibrillation (VF). EGM = electrogram.
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